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Revision > CVS Practice questions > Flashcards

CVS Practice questions Flashcards

1
Q

what is the remnant of the foramen ovale?

A

fossa ovalis

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2
Q

what is the remnant of the ductus arteriosus?

A

ligamentum arteriosum

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3
Q

a patient is having her heart function assessed by an echocardiography. if the EDV of her LV is 120 ml and her SV is 50ml what is her ejection fraction expressed as a percentage?

A

42%

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4
Q

what is consistent with an acute inferior non-STEMI?

A

ST depression in leads I, II and aVF

presence of troponin

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5
Q

a 64 year old man suffered severe chest pain whilst out shopping. the paramedics performed a 12 lead ECG. what findings would suggest a lateral myocardial infarct?

A

leads I, all, V5, V6

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6
Q

a 64 year old man suffered severe chest pain whilst out shopping. the paramedics performed a 12 lead ECG which showed signs of inferior STEMI. in which groups of leads would ST elevation suggest an inferior infarct?

A

II, III, avF

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7
Q

why does the chest pain in a patient with stable angina come on with exercise?

A

blood flow through the left coronary artery is compromised because diastole is shorter and the oxygen demand has increased

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8
Q

a patient suffering anaphylactic shock is given an injection of adrenaline to help raise her arterial blood pressure. what type of receptors does the adrenaline bind to to bring about the increase in arterial BP?

A

alpha 1 adrenoceptors

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9
Q

what drug would you give someone suffering an anaphylactic shock in order to maintain their blood pressure?

A

adrenaline

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10
Q

a young woman is running on a hot summer day. she feels a sharp pain in her arm but continues running. she begins to feel weak and unwell. eventually she collapses. she may be suffering from anaphylactic shock. what combination of cardiovascular signs might suggest this diagnosis?

A

flushed appearance
rapid pulse
low arterial BP

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11
Q

a young man is rushed to the emergency department having suffered a stab wound to the chest. there is very little blood loss. his pulse is rapid and weak. there is noticeable distension of the veins in the neck. his arterial BP is 90/60 mmHg. what type of shock do you think he is suffering?

A

mechanical

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12
Q

paramedics arrive on the scene to find a young man lying unconscious in a large pool of blood. he has sustained a stab wound to the groin. on assessment they determine that he is in hypovolaemic shock what do you think the state his arterial blood pressure, central venous pressure and peripheral resistance will be?

A

aBP decreased
CVP decreased
TPR increased

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13
Q

what is the correlation between maBP, HR, SV and TPR?

A

maBP= SV x HR x TPR

-> CO= SV x HR

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14
Q

a 78 year old woman has congestive heart failure (failure of both sides of the heart). she has developed peripheral oedema affecting her ankles. how will changes in the Starling forces at the capillaries have caused oedema at the ankles?

A

hydrostatic pressure at the capillaries will have increased due to raised venous pressure
- CVP increases as the R side of the heart is failing

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15
Q

left arterial pressure is being assessed in a patient using a specialised catheter with a balloon and pressure sensor at the tip. the patient’s left arterial pressure is elevated and ranges from 5-20 mmHg throughout the cardiac cycle, whilst the patient’s arterial blood pressure is 140/80 mmHg. what will be the pressure in the patient’s left ventricle in diastole?

A

5-20 mmHg

  • blood must e able to flow from the atrium to ventricle in diastole
  • normally, this presssure would be around 1-10 mmHg
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16
Q

in what way do vascular smooth muscle cells in systemic circulation respond to hypoxia?

A

relaxation

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17
Q

in what way do pulmonary vessels respond to hypoxia?

A

vasoconstriction

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18
Q

a 50 year old man had a routine blood pressure measurement at the GP surgery. three readings were taken and the results were consistently 140/95 mmHg. this was followed up by a 24 hr ambulatory blood pressure measurement which gave a value of 137/87 mmHg. how would his blood pressure be classified?

A

stage 1 hypertension

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19
Q

what is the fibrous layer of the pericardium?

A
  • outermost layer of the pericardium
  • tough and inelastic- will not readily stretch
  • therefore if excess fluid fills the pericardial space this can compress the heart
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20
Q

what is the parietal layer of the pericardium?

A

the serous layer that lines the outer fibrous layer of pericardium
- continuous with the visceral layer of pericardium

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21
Q

what is the pericardial space?

A

lies between the visceral and parietal layers of serous pericardium
normally has thin layer of serous fluid to allow the heart to move freely within the sac as it beats

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22
Q

what is the typical CO of a 70kg man at rest

A

5 L/min

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23
Q

describe preload

A

the amount the ventricles are stretched in diastole

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24
Q

a patient is having her heart function assessed by echocardiography. if the EDV of her LV is 120ml and the ESV is 80ml what is her ejection fraction expressed as a percentage?

A

33%

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25
Q

describe the route of the Right coronary artery

A

arises from the aorta above the right cusp of the aortic valve = right aortic sinus
runs in the groove between the atria and ventricles to reach the posterior aspect of the heart

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26
Q

describe the left anterior descending artery

A

down the anterior aspect of the heart over the inter ventricular septum
supplies the septum and anterior aspect of the L and R ventricles

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27
Q

what is responsible for setting the resting membrane potential in excitable cells ?

A

permeability to potassium

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28
Q

what part is responsible for setting the rate and rhythm in a normal heart?

A

sinoatrial node

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29
Q

what channel type is responsible for the upstroke of the AP in pacemaker cells

A

L- type calcium channels

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30
Q

which embryonic tissue gives rise to the cardiovascular system?

A

mesoderm

31
Q

In which week of development does the embryo fold?

A

4th

32
Q

what are the relative pressures in the atria in utero?

A

R atrial pressure greater than L atrial pressure

oxygenated blood from placenta arrives to RA via the umbilical vein draining into the IVC

33
Q

at birth, the pulmonary circulation starts. what happens to L atrial pressure?

A

increases

34
Q

what does the R coronary artery supply?

A

inferior aspect of the heart and right atrium

35
Q

what does the circumflex artery supply?

A

left lateral aspect

36
Q

what is the primary mechanism by which Glyceryl trinitrate (GTN) spray alleviates myocardial ischaemia in a patient with stable angina?

A

vasodilation of VEINS

37
Q

a patient with heart failure develops pulmonary oedema. the patient is already taking an ACEi. what type of drug would be most appropriate additional therapy to alleviate the pulmonary oedema and reduce the workload of the heart?

A

loop diuretic

38
Q

a 76 year old man with increasing breathlessness and a resting pulse rate of 100 bam has his cardiac ejection fraction assessed by echocardiography. his EDV is assessed as 80ml and his ESV is 40ml. what would you conclude about the functioning of his heart?

A

likely suffering from heart failure with a preserved ejection fraction

39
Q

a 58 year old man is investigated for acute onset chest pain in the emergency department. he has had no previous cardiac events. what events would be consistent with unstable angina?

A

ST depression in leads I, II and aVF but no troponin present

40
Q

an increase in intracellular calcium ion conc causes contraction in vascular smooth muscle cells. what do calcium ions ind to to initiate contraction?

A

calmodulin

41
Q

an increase in intracellular calcium ion concentration causes contraction in cardiac myocytes. what do calcium ions bind to to initiate contraction ?

A

troponin C

42
Q

during exercise the physiological levels of adrenaline increases due to release from adrenal medulla. what will be the effect of this adrenaline on vascular smooth muscle cells in skeletal muscle ?

A

activate beta 2 adrenoceptors to cause relaxation

43
Q

what is the effect of severe hyperkalaemia on the spread of APs throughout the myocardium?

A

cardiac myocytes hyperpolarise causing inactivation of sodium channels and slowing down the spread of APs

44
Q

define the term cardiac tamponade

A

increase of fluid in the pericardial space which causes increased pressure on the heart so it cannot fill properly
- limits EDV

45
Q

a 21 year old male has been stabbed. he is hypotensive, tachycardic, sweaty and has distended neck veins. explain each of the patient’s signs

A

hypotensive- decrease in CO- hypovolaemia- loss of blood due to stab wound (decrease blood pressure)
tachycardic- compensating for decreased pressure
sweaty- activation of SNS
distended neck veins- venous engorgement- raised CVP- back pressure into the neck

46
Q

A patient has a stab wound and has cardiac tamponade. what type of shock is this patient going into?

A

mechanical shock

- heart cannot distend fully

47
Q

what would be heard on auscultation with a patient with cardiac tamponade?

A

muffled heart sounds

as more fluid around the ventricles

48
Q

how is cardiac tamponade normally treated?

A

pericardiocentesis- drain from pericardial sack (drain in 5th or 6th intercostal space)

49
Q

describe the borders of the heart

A

superior- atriums
inferiors- right ventricle
left- left ventricle
right- right atrium

50
Q

what are three signs of hyperlipidaemia

A

xanthelasma- fatty deposits around the eyelid
xanthoma- over tendons of the hands
cornial arcus- white ring around iris

51
Q

explain the process of atheromatous plaque formation

A
  1. damage to endothelial lining/ arterial wall
  2. macrophages oxidise LDLs - form foam cells
  3. collage depositions - give fibrous cap over lipid core
52
Q

what is angina? outline the pathophysiology of angina

A
  • an area of muscle of the heart has reduced blood flow due to a partial occlusion of a coronary artery by an atheroma which causes pain
  • partial occlusion of coronary artery due to atheroma
  • heart rate increases and diastole decreases on exercise and so less filling of the heart therefore coronary artery filling time is reduced
53
Q

what medication is given for angina? explain the primary mechanism of action

A

GTN spray ( under the tongue )

  • VENOdilation
  • lowers work load
54
Q

outline ACS

A

chest pain at rest

  • plaque ruptures- constant wear and tear- capsule breaks down
  • platelet aggregation
  • collection of platelets - thrombus (clot)
  • nearly completely occludes the vessel

unstable angina, NSTEMI and STEMI

55
Q

what are the differences in the subtypes of ACS

A

unstable angina
- ischaemia but no necrosis -> (-) troponin test
ST depression and T wave inversion

NSTEMI
- partial or brief occlusion which causes necrosis but not entire wall of muscle -> (+) troponin
ST depression or T wave inversions

STEMI
- whole ventricle wall is necroses -> (+) troponin
ST elevation

56
Q

what is seen with atrial fibrillation

A 
irregularly regular rhythm 
no p waves 
wavy baseline
narrow QRS - irregular PR intervals 
HR and pulse irregular
57
Q

what effect will atrial fibrillation have on EDV of the ventricles?

A

little decrease
ventricles will contract which will be sufficient for CO
when atrias contract this only adds a small amount of blood into the ventricles

58
Q

why is there a chance to develop a stroke after atrial fibrillation?

A

clots in atria due to stasis of flow and turbulence as not contracting properly
production of thrombus which is pumped out of ventricles to brain -> stroke

59
Q

an X-ray of a chest showed cardiomegaly. how is this concluded from an x-ray?

A 
= enlargement of the heart
Cardiothoracic ratio 
measure entire width of the heart at widest diameter
width of rib cage at same level
if >50% of chest width then cardiomegaly
60
Q

what are the four features of tetralogy of Fallot? is this a cyanotic or an acyanotic defect?

A

POSH

  • pulmonary stenosis
  • overriding aorta
  • Ventricular septal defect
  • RV hypertrophy
    cyanosis: R -> L
61
Q

what type of murmur is heard in a patent ductus arteriosus?

A

continuous murmur between systole and diastolic
machinery murmur
- since the pressure on the L side of the heart is higher throughout the cardiac cycle is always moving from the aorta to pulmonary artery

62
Q

after birth, in which direction will blood flow through a patent ductus? what might be the consequences for the circulation of the baby?

A
  • Left to right (aorta to pulmonary trunk)

- R ventricular overload

63
Q

what normally makes the ductus arteriosus close at birth?

A
  • increased oxygen levels
  • reduction in circulating prostaglandins
    = causes contraction of smooth muscle cells
64
Q

in the foetus, which has the highest vascular resistance- the pulmonary or systemic vascular bed?

A

pulmonary

65
Q

Describe the ECG changes expected for an acute myocardial infarction. why might these ECG changes be more prominent in some of the twelve ECG ‘leads’ than others?

A
  • initial change ST elevation
  • later changes would be T- wave inversion and pathological Q- waves
  • changes will be more prominent in those leads ‘looking at’ the infarcted area
66
Q

state the positions of the ECG leads

A 
v1- 4th ICS R of sternum 
v2- 4th intercostal space L of sternum
v3- between v2 and v4
v4- 5th ICS midclavicular line
v5- between v4 to v6
v6- 6th ICS midaxillary line
67
Q

a blood sample is taken to look for a marker of myocardial infarction. what marker is measured?

A

cardiac form of Troponin I or Troponin T

68
Q

what is ventricular fibrillation?

A

abnormal rapid ventricular activity with loss of co-ordinated contraction

69
Q

what effect will VF have on cardiac output?

A

loss/ dramatic drop in CO

70
Q

what is the principle behind the use of a defibrillator?

A

depolarises the heart

stops all electrical activity, allowing re- coordination of the cardiac impulse

71
Q

describe the mechanism by which local anaesthetics (eg lidocaine) prevent ventricular fibrillation

A
  • lidocaine blocks fast sodium channels in the open or refractory (inactivated) state
  • it will block sodium channels in damaged (depolarised) tissue
72
Q

a patient mistreated with glyceryltrinitrate. what does this drug do? what is the principle mechanism of action?

A
  • reduces the workload of the heart by causing venodilation (reduces preload)
  • also causes dilation of arteries (not arterioles)
  • including collateral coronary arteries and may improve blood supply to the heart
  • mechanism of action- relaxation of vascular smooth muscle
73
Q

name 3 organs in the body on which a non- selective beta adrenoreceptor antagonist will act. list in each one the effects of its action

A

heart- slow HR and reduce contractility
lungs- bronchoconstriction
blood vessels in skeletal and cardiac muscle- vasoconstriction via blocking beta 2 receptors
–> if it was very unselective and also acted at alpha 1 receptors on peripheral vessels it would cause vasodilation
liver- decrease glycogenolysis

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